A medical practice in the Hampshire area

5. Mr S complains about his experiences at a medical practice in the Hampshire area (the Practice), which he states has been ongoing for since April 2017. He says:

6. He has suffered a lack of care and service at the Practice since April 2017 and has complained locally about this on several occasions.

7. He is unhappy with new ordering process of prescriptions that the Practice has put in place during the pandemic, since May 2020

8. He is unhappy with a warning letter sent to him on 30 July 2020, and feels the accusations made against him are false.

9. He felt humiliated when on 1 September 2020 he was asked to leave the Practice by a doctor.

10. Mr S says because of this experience his mental health and wellbeing have deteriorated, and he is now under supervision from the local Community Mental Health Team. He has also been left feeling humiliated, deeply offended, and threatened.

11. Mr S says he just wants closure, a resolution, and a full apology from the Practice over his treatment.

12. Mr S has told the PHSO that his ill treatment, and the need to complain about the Practice started in April 2017. He says he wrote letters to the Practice in the hope of getting a local resolution.

13. On 23 July 2020, an incident happened at the Practice where Mr S was told that due to COVID-19 he had to follow a new process to get a repeat prescription. This process involved writing what repeat medications he needed and putting it in a post box in the Practice reception. Mr S did not do this, and an altercation happened. Practice staff reported he was aggressive and abusive, and he was asked to leave.

14. On 30 July and 18 August 2020, Mr S was sent letters by the Practice saying that his behaviour on 23 July 2020 had been ‘increasingly abusive and intimidating’. He was also warned that if his behaviour continued he would be removed from the Practice list.

15. On 1 September 2020, Mr S was invited to a face-to-face meeting by the Practice to discuss ‘numerous’ letters he had sent. During the meeting, which took place during a GP consultation, it was reported by a GP that Mr S’s behaviour was unacceptable. Mr S agreed to a referral to the local mental health team. He refused to leave the Practice despite being asked to leave, and he was escorted off the premises.

16. In a letter dated 3 September 2020, Mr S told the Practice that because of the incident on 1 September 2020, he had been caused further ‘stress and anxiety’ due to the way the GP had treated him both in the consultation and in escorting him out of the Practice. He denied being abusive or aggressive. He said the GP had acted like that towards him.

17. Mr S finally sent a ‘formal complaint’ to the Practice on 22 October 2020. He said his complaint was about ‘incompetence’, being treated with disrespect, ‘contempt, inpertinence [sic], insolence- indignity’. He said he had been ‘humiliated’. Mr S noted the behaviour of the staff was continuing to affect his mental health and this had been discussed with his Community Psychiatric Nurse. He noted two doctors at the Practice had not responded to his letters. He asked for a final response from the Practice to his letter of complaint.

18. The Practice promptly acknowledged Mr S’s letter on 27 October 2020. The Practice Manager advised the local resolution process would be followed. As part of the local investigation, three incident forms were filled from staff on the incident of 23 July 2020, which all corroborate the unacceptable behaviour of Mr S towards all the staff involved.

19. On 5 January 2021, Mr S was sent a full complaint response by the Practice. The Practice noted they stood by the warning letter he had been sent regarding his behaviour.

20. Mr S disagreed with the local resolution process findings in a letter dated 10 February 2021.

21. On 4 March 2021, the Practice sent Mr S a final response to his complaint. They upheld the view that his behaviour on 23 July 2020 had been unacceptable.

Mr S suffered a lack of care and service at the Practice since April 2017 and has complained locally about this on several occasions

24. The law (Health Service Commissioners Act 1993) says a person needs to make their complaint to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to do so.

25. We have discussed this with Mr S to understand the reasons why he could not bring his complaint to us earlier. We have also considered the time the organisation has taken to respond to Mr S.

26. During our conversations with Mr S on 27 October 2021, we were made aware that Mr S knew of a reason to complain in April 2017. Mr S says while he is complaining about a recent warning letter from the Practice, along with a change in the prescription ordering process, he has had ongoing complaints with the Practice since 2017. He has said he was aware of the need to complain in April 2017 and did not contact the PHSO sooner as he wanted it dealt with locally.

27. Mr S reiterated that the matter has been ongoing since April 2017, and he has complained so much because the issues have not been resolved. It was explained that the Practice had sent the complaint file, and it only relates to matters in the months preceding his complaint form from March 2021.

28. We have taken 2017 as the date Mr S knew he had a reason to complain about aspects of the care and service offered by the Practice.

29. We can see that Mr S raised a formal complaint on 22 October 2020. The Practice were prompt to deal with his complaint, taking four months, with a final response being sent on 4 March 2021. We have also seen evidence that the Practice replied to Mr S’s letters.

30. As part of our consideration of complaints, at preliminary investigation stages, we are required to ask about the reasons for any delays in bringing a complaint to us. We gave Mr S the opportunity to provide details, and Mr S cites issues with the Practice and the need to continue pursuing his concerns with the care and service for the period in this complaint. Taking that into consideration, the date at which a formal complaint was raised is 22 October 2020.

31. During our conversation, we enquired if there were any barriers to Mr S complaining about matters sooner. We have not been made aware of any. Mr S cited the incompetence of the staff at the Practice as a barrier.

32. Though we recognise Mr S promptly brought matters to us on 7 March 2021, after the formal local resolution was completed on 4 March 2021, it is our view there are no justifiable reasons, or any barriers to consider, in the amount of time taken to reach this point. It is our view Mr S could have sought to complain formally sooner. As such we consider this aspect of the complaint is out of time.

Unhappy with new ordering process of prescriptions that the practice has put in place during the pandemic since May 2020

33. Before we decide if we should investigate a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. In doing so, we have not found any indications that something has gone wrong. The change in the repeat prescriptions process was implemented at the Practice in response to the COVID-19 pandemic and we would not be critical of this implementation.

34. On 23 July 2020, an incident occurred where Mr S was critical of the new prescription ordering process at the Practice. Rather than repeat prescriptions being taken face to face by reception staff, the Practice decided to minimise face to face contact between staff and patients. This was to avoid spreading COVID-19 and as such repeat prescription orders would need to be written down and posted into a specific box at the Practice. Mr S did not comply with this process and felt frustrated. This led to a situation where staff felt he was being ‘aggressive and intimidating’. He complained about the new process in subsequent letters to the Practice.

35. The supportive clinical guidance for this implementation was NHS (19 March 2020) ‘Preparedness letter to primary care’.

36. This guidance published early in the pandemic was in place to allow practices to adopt safe procedures to avoid face to face contact. Where critical services were needed to be maintained, new processes were implemented. The change to the repeat prescription process, while quite limited in simply writing down the medications needing to be repeated, ensured that face-to-face contact between staff and patients was minimised.

37. On 28 October 2021, during a telephone call between the PHSO and the Practice, we asked it whether Mr S has any reasonable adjustments in place that would have allowed him to follow the previous face-to-face process. They said that he had two ‘alerts’ on his medical records which allowed him to order medication over the phone, and that he was allowed to be put through ‘on demand’ to the Practice Manager should he have any issues. Mr S was therefore already given significant dispensations in the way he ordered medication, and in his communication with the Practice.

38. Overall, we would not be critical of the Practice changing their processes in response to national guidelines, based on the need to avoid both patients and staff being infected with COVID-19. For this reason, there was no maladministration on behalf of the Practice.

Not treated with dignity or respect, falsely accused, and had allegations fabricated against him and felt humiliated when asked to leave the surgery by doctors at the Practice

39. There have been several reported instances of Mr S being aggressive and intimidating towards staff, witnessed by other staff and other patients.

40. For any service provider, we would never be critical of the provider implementing their unreasonable behaviour policy for the protection and safety of their staff and patients. We would only consider if the application of the policy was delivered correctly.

41. In his complaint form to us, Mr S said that he had been given no explanations about why he had been falsely accused in a warning letter from the Practice. He says that for six months he ‘had to endure false accusations, false claims and fabricated reports’.

42. A warning letter was sent to Mr S on 30 July 2020 in which the Practice outlined their reasons, and said his behaviour was contrary to their policy of a ‘zero tolerance’ on ‘abusive’ behaviour. A further letter on 18 August 2020 was sent mentioning the ‘zero tolerance’ policy after Mr S replied to the letter of 30 July 2020. Mr S also says he was denied the opportunity for any further discussions on the matter. The ‘zero tolerance’ policy does not stipulate whether discussions or any negotiations on the matter are part of the process but sets out what will happen if the Practice considers behaviour unreasonable enough to warrant using the policy.

43. During a call between PHSO and Mr S on 27 October 2021, Mr S informed us that behaviour was ‘not aggressive, just assertive’.

44. The Practice says that an incident occurred on 23 July 2020, where Mr S was ‘aggressive and intimidating’. In a letter to Mr S, dated 30 July 2020, it said that his behaviour while talking to two members of staff ‘became increasingly abusive and intimidating. This was witnessed by a number of people’. This was further documented in an Incident Report Form where a member of staff who gave an account said:

45. ‘The reception staff seemed shaken, and I believe one of reception team was crying as a result. The patient was demanding that a prescription was to be issued there and then was shouting when he didn’t receive what he wanted. He was refusing to engage with the receptionist who were offering that they would pass a written prescription request to the duty doctor’.

46. The Practice implemented the NHS-wide ‘Zero Tolerance’ Policy in 2019. This policy sets out the expectations of unreasonable behaviour and actions taken as a result. It says:

47. ‘All incidents will be followed up and you will be sent a formal warning after a second incident or removed from the practice list after a third incident if your behaviour has been unreasonable.’

48. Though we have statements, in line with our own policy (Service Model Guidance), we must consider the impartiality of those making statements. In this instance we have statements from staff. It is our view these do help outline the situation, but we would not consider these, compared to a hearsay witness statement, as impartial or neutral. Our own policy is explicit that on occasions there will be times when progressing to a full investigation is neither practical nor would provide any further results on which to reach a view.

49. On this occasion, it is our view even if we were to investigate, we would still be faced with the same challenges in obtaining reliable detailed witness statements from independent hearsay witnesses. This is because of the time taken since the event, and the proportionality of seeking those statements. For those reasons, we adjudicate this aspect under our own general discretion as other reason to decline.

50. In this circumstance, it appears the Practice followed its own policy correctly; it wrote to Mr S giving reasons for concern, and it was explained that if he continued to be ‘verbally abuse, aggressive or intimidating to any staff member at the Practice this will result in [his] removal from the practice list with immediate affect [sic.]’. For this reason, we have seen no indication of a failing.

1. We have carefully considered Mr S’s complaint about a medical practice in the Hampshire area (the Practice). We have decided that aspects of the complaint fall outside of our time limit. There are also no indications of maladministration, or indications of failings.

2. We have decided that Mr S should have approached the Parliamentary and Health Service Ombudsman (PHSO) sooner, as he was aware of the need to complain about a lack of care and service at the Practice since April 2017. This means that this element of his complaint is two years and 11 months out of time. We have seen no barriers to Mr S bringing his complaint to the PHSO sooner.

3. We have also seen no evidence of maladministration, with the Practice saying that the change in ordering prescriptions was due to COVID-19. The change in the repeat prescriptions process was implemented at the Practice in response to the COVID-19 pandemic, and we would not be critical of this implementation.

4. We understand that Mr S felt like he was not treated with dignity or respect, and allegations were fabricated against him in response to a warning letter he was sent. However, we have seen no failings in the Practice’s implementation of the policy and cannot reach a view on the allegations made.